Provider Demographics
NPI:1548981426
Name:DOUGHERTY, JOANNA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LYNN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CASSARO LN
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8959
Mailing Address - Country:US
Mailing Address - Phone:919-329-3413
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1177
Practice Address - Country:US
Practice Address - Phone:919-207-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist